Responses of the hypothalamic-pituitary-adrenal and renin-angiotensin axes and the sympathetic system during controlled surgical and anesthetic stress.

摘要: We studied the responses of plasma CRH, ACTH, cortisol, norepinephrine, epinephrine, and renin activity in 11 patients undergoing parathyroid or thyroid surgery after identical preoperative sedation during isoflurane (Forane) anesthesia. During surgical exploration, CRH levels [10 +/- 2 (+/- SEM) pg/mL] remained at basal (unstimulated) levels, ACTH (11.5 1.4 pg/mL), cortisol (24 4 micrograms/dL), epinephrine (35 10 pg/mL) concentrations within their normal morning ranges. The majority had no evidence pulsatile secretion operation, but, rather, secreted continuously. There was a small elevation norepinephrine PRA which associated with increase heart rate decrease blood pressure. Anesthesia reversal, endotrachial extubation, early recovery period were marked mean peak increases (173 45 6 (220 56 return to levels. All hormones returned by first post-operative day. data suggest that modern anesthetic techniques neck mildly elevated Glucocorticoid operation maintained primarily continuous rather than secretion. immediate postoperative profound elevations epinephrine. major determinant anesthesia reversal not trauma.